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Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

Several treatment modalities have been reported for patients with arthrogenous temporomandibular disorders. The most common temporomandibular disorder is internal derangement, usually accompanied by displacement of the articular disc. Most often anteriorly and medially displaced, patients may develop clicking, impaired jaw function, and pain. Articular disc repositioning has been described as an effective method to eliminate interference during mandibular translation, improving mandibular range of motion, and eliminating pain. In this article, we present a new, simple, and reproducible technique without requiring specific instruments for repositioning and suturing the articular disc with posterior anchorage fixed to the tragus cartilage. It has the advantages of a better anteroposterior vector of traction force, without adverse effects as lateralization of the articular disc and skin depression, commonly presented in other techniques., (Copyright © 2023 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Disclosure The Authors have nothing to disclose.

Purpose: Long-term TMJ dislocation is a rare condition. It occurs when an acute luxation remains untreated in time., Methods: A 52-year-old man presented with a long-term TMJ luxation in the context of Steinert's disease. A discectomy together with condylectomy and eminectomy was performed, obtaining an adequate reduction of the luxated condyle and disc., Results: Twelve months after the operation, the condition has not recurred at all. A stable and centred occlusion was checked; his MIO was over 30 mm., Conclusion: The combination of these three techniques could be a good option in cases of Steinert's myotonia, where the condyle luxation becomes chronic and irreducible due to the altered neuromuscular condition. There is still no consensus regarding the treatment for long-term TMJ dislocations. New and more solid studies may be needed in order to find adequate treatment protocols for this condition., (© The Association of Oral and Maxillofacial Surgeons of India 2019.)

Introduction: The role of temporomandibular joint (TMJ) surgery is not well defined due to a lack of quality randomized controlled clinical trials, comparing different TMJ surgical treatments with medical and placebo interventions. The temporomandibular joint interposal study (TEMPOJIMS) is a rigorous preclinical trial divided in 2 phases. In phase 1 the authors investigated the role of the TMJ disc and in phase 2 the authors evaluated 3 different interposal materials. The present work of TEMPOJIMS - phase 1, aims to evaluate histopathologic and imaging changes of bilateral discectomy and discopexy in Black Merino sheep TMJ, using a high-quality trial following the ARRIVE guidelines., Material and Methods: This randomized, blinded and controlled preclinical trial was conducted in 9 Black Merino sheep to investigate histopathologic (primary outcome), imaging and body weight (secondary outcomes) changes after bilateral discectomy, discopexy and sham surgery., Results: Significant changes were noticed in discectomy group, both in imaging and histopathologic analyses. Body weight changes were most pronounced in the discectomy group in the first 4 months after surgery with recovery to baseline weight 6 months after surgery. Discopexy induced nonsignificant changes in histopathologic, imaging and body weight analyses., Conclusions: This study reinforces the importance of developing an effective interposal material to substitute the TMJ disc and the need to explore the molecular mechanisms that underlie TMJ cartilage degeneration. The study design proposed in TEMPOJIMS represents an important progress towards future rigorous TMJ investigations., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. All rights reserved.)

Objectives: It has been speculated that certain Schneiderian membrane thickness (SMT) might be more prone to perforation. This investigation was aimed at studying the mechanical characteristics of the Schneiderian membrane under one- and two-dimensional tests and their correlation to the histological SMT in human samples., Material and Methods: Sixteen Schneiderian membranes were collected from 11 cadaver heads treated with Thiel's embalming method. The samples were processed and analyzed clinically and histologically. One-dimensional maximum elongation until perforation and two-dimensional resistance to ball penetration were performed after the biopsy. Data was analyzed by using the Wilcoxon rank test and the Spearman's rank correlation., Results: The histological SMT was 1.36 ± 0.42 mm, whereas the clinical thickness was 0.27 ± 0.21 mm, yielding statistical significance (p = 0.000). The resistance under ball penetration was 0.59 ± 0.43 N and the mean maximum elongation in the one-dimension test 11.19 ± 7.14 mm. Expressed in percentage, the mean stretch was 241.36 ± 227.97% (range 31.5 up to 947%). A weak positive correlation was found between the ball penetration test and the SMT (r = 0.10, p = 0.711), while a weak negative correlation was found between stretching test and the SMT (r = -0.021, p = 0.94)., Conclusions: Mechanical tests seem to indicate that SMT might not significantly predispose to Schneiderian membrane perforation. Hence, other anatomical and operator's factors should be considered of surpassing importance., Clinical Relevance: Thinner SM might be more prone to perforation when detaching it from the maxillary sinus antrum; however, a thick membrane is not prevented to tear, as their resistance under elastic forces is not higher than thinner ones.

Purpose: The purpose of the present study was to establish the reliability of fine needle aspiration (FNA) in the diagnosis of malignant salivary gland tumors in our population and to compare our results with those of other authors., Material and Methods: This was a retrospective study of clinical data from 172 patients, 153 parotid tumors and 19 submandibular tumors who underwent preoperative FNA between January 2004 and December 2013. Sensitivity, specificity, positive and negative predictive values of FNA for the preoperative diagnosis of malignancy were analyzed., Results: For the diagnosis of malignancy an S value of 60% was obtained, which means that 40% of malignant tumors were not diagnosed by FNA. Besides an E value of 97.5% was obtained, thus indicating that FNA was negative for malignancy in up to 97.5% of all benign neoplasms. According to predictive values, we observe that FNA hit in 83.3% cases given as malignant and in 92% of cases giving as benign (PPV=83,3%; NPV=92%)., Conclusion: With a scarce 60% sensitivity value in our series, fine needle aspiration has evident limitations for diagnosis of malignancy in major salivary gland neoplasms. Being highly conditioned by the staff and the conditions in which it is performed, FNA is a complementary test that helps the preoperative diagnosis of the major salivary glands with radiological tests, medical history and physical examination, but that alone it is not defining of malignancy., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to compare solvent dehydrated human allograft (SDHA; Puros Allograft) and freeze-dried human allograft (FDHA; MinerOss) in order to determine if the allogeneic bone preservation process influences the amount of remaining particles and newly formed bone in maxillary sinus augmentation., Materials and Methods: Subjects requiring maxillary lateral sinus augmentation with ridge height < 5 mm were included in this study. Maxillary sinuses were randomly assigned to be grafted with a 1:1 ratio of cortical and cancellous bone, either SDHA or FDHA. In both groups, the graft material was mixed with autogenous bone graft at a ratio of 1:1. Morphologic and histomorphometric analyses were completed 6 months after the grafting procedure., Results: Thirty-four subjects were included in this study. All subjects showed similar demographic characteristics at baseline. Half of the sinuses were grafted with SDHA; the remaining half were grafted with FDHA. Histomorphometric analysis of bone core biopsy samples showed no statistically significant difference between the SDHA or FDHA allogeneic bone substitutes (P = .365), with a mean value of 39.54% ± 0.05% and 31.96% ± 0.08% of mineralized tissue for SDHA and FDHA, respectively. However, a slightly higher mean value of remaining particles was obtained for the FDHA compared with SDHA (18.91% ± 0.09% vs 8.65% ± 0.06%, respectively), although the difference was not statistically significant. Additionally, FDHA demonstrated statistically significantly higher osteoblast, fibroblast, and inflammatory cell numbers., Conclusion: Regardless of the preservation process subtype, allogeneic bone grafting material, in combination with autogenous bone, was demonstrated to be effective for maxillary sinus augmentation bone by means of cellular, vascular, and histomorphometric behavior. Nonetheless, FDHA demonstrated higher cellularity compared to SDHA, suggesting accelerated turnover activity for the latter grafting material.

Maxillary sinus membrane perforation has been reported as the most common intraoperative complication during sinus augmentation, potentially leading to postoperative infection and consequent loss of graft or even implant failure. Numerous anatomical factors have been demonstrated to affect membrane tearing. However, careful use of proper instrumentation, such as a reamer, seems to play an important role in minimizing the incidence of these complications. Hence, the aim of the present study was to (1) investigate the reliability of reamer drilling for lateral window preparation; (2) examine the incidence of membrane perforation; and (3) study the factors that might influence membrane perforation. Results from this study showed the safety and effectiveness of using a reamer to perform lateral window approach sinus augmentation. The sinus membrane perforation rate was found to be 12.5%. A slightly higher perforation rate was noted in thinner maxillary lateral walls (< 1.25 mm). The authors concluded that reamer drilling is a safe and effective alternate technique for opening the lateral window wall when the lateral wall thickness is ≥ 1.25mm.

Mucormycosis is a lethal fungal disease with a general poor prognosis. Rhinocerebral presentation is the more frequent form. The purpose of this study was to review and show our experience in the management of 5 cases of mucormycosis of the head and neck with different clinical presentations. The high suspicion led us a prompt diagnosis and aggressive surgical treatment that allowed a good outcome in our series., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: The effect of the wide long-wave CO2 laser is the thermal vaporization of the tissues, getting a maximum energy concentration with a minimum of tissue penetration. In oral surgery, it is generally used for the treatment of oral and oropharyngeal small mucous tumors, due to the scarce morbidity that takes place and the absence of reconstructive necessity., Objective: To analyze the postoperative evolution, in the patients treated by oral and oropharyngeal epidermoid carcinomas, after CO2 laser resection. To compare it with that of the patients treated by means of conventional surgical methods, achieving the reconstruction through direct suture or the employment of local, regional or distance flaps., Methods: A prospective study was designed including 70 patients treated by oral and oropharyngeal epidermoid carcinomas. Thirty-five patients were treated by means of CO2 laser, in 10 cases direct wound-closure was realized, and in the remaining 25 patients some local, regional or distance flap were used. There were analysed the presence of postoperative pain, the degree of cicatricial retraction, and the speech and swallowing functional results., Results: We obtained a smaller painful degree and postoperative cicatricial retraction by the employment of CO2 laser. It permits minimizing the functional speech sequels (better words articulation) and swallowing (effective and precocious functional recovery)., Conclusion: CO2 laser resection has become the elective treatment for small oral and oropharyngeal epidermoid carcinomas. The reasons are the absence of reconstructive surgery necessity, the scarce cicatricial retraction, and the excellent postoperative evolution.

25 cases in which the mandible was resected and reconstructed using a reconstruction plate (AO titanium reconstruction system and Leibinger titanium reconstruction system) are presented. 16 patients suffered from oral carcinoma, 7 presented with odontogenic tumours and 2 had chronic osteomyelitis of the mandible. The mean age was 54.2 years, the male to female ratio was 2.6:1. 3 patients had a reconstruction plate for mandibular resection without continuity defect (marginal resection), in all the other patients the reconstruction plate bridged a mandibular resection with a continuity defect: 13 were located in the body, body-angle or ascending ramus with preservation of the mandibular condyle; 4 hemimandibulectomies with disarticulation of the TMJ; and 5 involved the anterior arch, crossing the midline. 12 patients received radiotherapy (3 pre-operatively). Only 3 patients with significant local side effects needed the treatment to be stopped for a period of time. There was no perioperative mortality. Only one plate was removed. Although minor complications were noted in 11 patients, the general improvement in the functional and cosmetic balance of the patients when compared with patients in whom no plate was used, justifies the use of this reconstruction system, in our opinion.

Intravascular Papillary Endothelial Hyperplasia (IVPEH) is a benign process, even uncommon. It was first described by Masson in 1923 under the name "Hemangioendotheliom vegetant intravascular". We present a case of IVPEH located in the masseter muscle. The treatment for this lesion was surgical excision. The histological examination is very important in order to separate this lesion from angiosarcoma.

Dens invaginatus is an abnormal enamel growth first described by Salter in 1855. It has an incidence between 0.4 - 10%, and the tooth most frequently affected is the lateral upper incisor. Its etiology is not explained. There are many asymtomatic cases and others with symptoms derived from periapical lesions. Treatment must be as conservative as possible. A bibliographic review has been made and we demonstrate a radiologic sequence of the many cases observed in our Service in the last two years.

The facial palsy produced by a parotid tumour, could be misdiagnosed due to the absence of a palpable mass or other any signs in the computerized axial tomography or nuclear magnetic resonance. However there are data derived from the facial anatomy, course and clinical characteristics from the palsy that could make us thinking on the presence of a parotid tumour. The objective of this article is to present this characteristics, together with a serial of clinic cases which coursed in the beginning with a facial palsy and had problems in their diagnostic. It's also remarked the significance of the presence or not of perineural infiltration to the parotid tumours that will condition not only the prognosis but also the clinic course.

The malignant schwannoma is a sarcoma which very rarely occurs on the face. This article describes the case of a woman with such a tumour and whose study and evolution shows that was no relation with the nervous trunk, neurofibroma or neurofibromatosis.